AHRQ Review: Consistent Definition Lacking for “High Performing” Health System

Health services research currently lacks a consistent definition of a “high performing” health care delivery system despite an increased emphasis by health care purchasers, payers and policymakers on measuring and rewarding such systems, according to an AHRQ-funded systematic literature review. Without a consistent definition, the review authors indicated, it is less meaningful to compare the performance of different systems and severely limits the ability to develop a general policy, or reward system, for achieving high performance. Although all definitions found in the literature review used one or more attributes to define high performance, only five studies used five or more attributes. Of the attributes used most often – quality, cost, access, equity, patient experience and safety – quality and cost were most commonly paired. This research was funded by AHRQ’s Comparative Health System Performance Initiative, which studies how health care delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. Access the abstract, published July 10 in the Joint Commission Journal on Quality and Patient Safety.

What Defines a High-Performing Health System: A Systematic Review

Sangeeta C. Ahluwalia, PhD

Correspondence information about the author PhD Sangeeta C. Ahluwalia

Email the author PhD Sangeeta C. Ahluwalia

Cheryl L. Damberg, PhD

Marissa Silverman, MPH

Aneesa Motala, BA

Paul G. Shekelle, MD

DOI: http://dx.doi.org/10.1016/j.jcjq.2017.03.010

Article Info

Background

Purchasers, payers, and policy makers are increasingly measuring and rewarding high-performing health systems, which use a variety of definitions of high performance, yet it is unclear if a consistently applied definition exists. A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a “high-performing” health care delivery system.

Methods

Searches were conducted for English-language articles defining high performance with respect to a health care system or organization in PubMed and WorldCat databases from 2005 to 2015 and the New York Academy of Medicine Grey Literature Report from 1999 to 2016. The entity/condition to which the definition was applied was extracted from included articles. The number and type of dimensions used to define high performance within and across articles was tabulated and the number and type of metrics used by performance dimension and by article was calculated.

Results

No consistent definition of a high-performing health care system or organization was identified. High performance was variably defined across different dimensions, including quality (93% of articles), cost (67%), access (35%), equity (26%), patient experience (21%), and patient safety (18%). Most articles used more than one dimension to define high performance (75%), but only five used five or more dimensions. The most commonly paired dimensions were quality and cost (63%).

Conclusion

The absence of a consistent definition of what constitutes high performance and how to measure it hinders our ability to compare and reward health care delivery systems on performance, underscoring the need to develop a consistent definition of high performance.